Added Actvities-Beer and Wine Grocery Stores-Spirits Retailers



Licensing and Regulation1025 Union Ave SEPO Box 43098 Olympia WA 98504-3098Phone: 360 664-1600 Fax: 360 753-2710lcb. FORMTEXT ?????License Number FORMTEXT ?????UBI Number FORMTEXT ?????Trade NameADDED ACTIVITIES FORBEER AND WINE GROCERY STORES AND/OR SPIRITS RETAILERSAdded Activities Processing InformationPlease answer all sections of this form that apply to you. Incomplete forms cannot be processed.Submit this form with any additional required documents to the above address.The section, Central Warehousing for Only Wine and/or Spirits, requires additional documents to be submitted with this form.If you have questions, please call Customer Service at 360-664-1600.Do you want any of the following activities?If you answer Yes to any of the activities below, answer all of the questions that apply to your business. If you answer No to all of the activities, your signature and date is all that is required. BEER / WINE GROCERY STORESSPIRITS RETAILERSCooking Classes FORMCHECKBOX Yes FORMCHECKBOX NoDelivery of Spirits FORMCHECKBOX Yes FORMCHECKBOX NoDelivery of Beer or Wine FORMCHECKBOX Yes FORMCHECKBOX NoInternet Sales FORMCHECKBOX Yes FORMCHECKBOX NoInternet Sales FORMCHECKBOX Yes FORMCHECKBOX No Sales outside of WA FORMCHECKBOX Yes FORMCHECKBOX No Curbside Service FORMCHECKBOX Yes FORMCHECKBOX No If you checked Yes for Internet Sales, will you be using a third party internet provider? FORMCHECKBOX Yes FORMCHECKBOX NoPlease list the name of the third party internet provider: FORMTEXT ?????Where will the sale of your products (including alcohol) take place? FORMTEXT ?????How do you plan to deliver the product? FORMTEXT ?????How will you be certain only people 21 or older make the purchase and receive the delivery? FORMTEXT ?????Other FORMTEXT ?????(This form is continued on the back page.) Added Activities for Beer and Wine Grocery Stores/Spirits Retailers Central Warehousing for Only Wine and/or Spirits(See #3 in Processing Information above) FORMCHECKBOX Yes FORMCHECKBOX NoIf Yes, go to the WSLCB Licensing Forms web page. Select, complete and submit the Warehouse Registration Form with all its required documents.I certify under penalty of perjury under Washington State law that the foregoing is true and correct.Print Name: FORMTEXT ?????Date: FORMTEXT ?????Signature:Phone: ( FORMTEXT ?????)–( FORMTEXT ?????)-( FORMTEXT ?????) Print Title: FORMTEXT ?????E-mail FORMTEXT ?????(for example, sole proprietor, corporate officer, partner, LLC manager or member.) ................
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